Fosamax vs Evista

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For patients with osteoporosis or those at high risk of developing this condition, certain drugs that alter the balance between bone formation and bone breakdown can help in slowing down bone loss, improving bone density and reducing fracture risk. Fosamax and Evista are two such drugs that are often prescribed for osteoporosis treatment. They each work differently on your bones but both have effects in maintaining or increasing bone mass in individuals with osteoporosis. Fosamax is a type of drug known as a bisphosphonate which works by inhibiting cells responsible for the breakdown of bones (osteoclasts). On the other hand, Evista belongs to a class of drugs called selective estrogen receptor modulators (SERMs), it mimics estrogen's beneficial effects on bone density without some of the risks associated with long-term use of hormone replacement therapy.

What is Fosamax?

Alendronate (the generic name for Fosamax) was one of the first drugs of the bisphosphonates class to be approved by the FDA in 1995. It marked a significant development over earlier classes of osteoporosis treatments, such as hormone replacement therapy. Fosamax works by slowing down bone loss, effectively increasing bone mass and reducing the chance of fractures. It is prescribed primarily for postmenopausal women and people with certain types of osteoporosis.

Raloxifene (Evista), on the other hand, belongs to a different group called selective estrogen receptor modulators (SERMs). First approved by FDA in 1997, it mimics some effects of estrogen on bones without affecting other tissues that respond to this hormone - like breasts and uterus- which leads to fewer side effects compared to hormonal therapies. While both medications are used in prevention or treatment of osteoporosis, their influence on body differs: while Alendronate has a more direct effect on overall bone density, Raloxifene's impact is especially prominent at spine level.

What conditions is Fosamax approved to treat?

Fosamax is approved for the treatment of various bone-related conditions:

  • Osteoporosis in postmenopausal women to increase bone mass and reduce the incidence of fractures, including those at hip and spine
  • To increase bone mass in men with osteoporosis
  • For the treatment of glucocorticoid-induced osteoporosis in men and women receiving glucocorticoids in a daily dosage equivalent to 7.5 mg or greater prednisone and who have low bone mineral density
  • Treatment to increase bone mass in men with osteopenia.

How does Fosamax help with these illnesses?

Fosamax helps to manage osteoporosis by slowing down the process of bone loss. It does this by inhibiting a type of cell called osteoclasts, which are responsible for breaking down old bone tissue so new tissue can be formed. When these cells are inhibited, less bone is broken down and there is more time for new bone to form, thus helping to maintain or increase overall bone density. Bone is a dynamic tissue that serves many functions in the body including support, protection of soft tissues, storage of minerals like calcium and phosphate and others.

On the other hand, Evista works differently because it mimics some effects of estrogen (a hormone) on bones without affecting other parts of the body where estrogen has activity like breast and uterus. Estrogen typically protects against bone loss; however its level drops significantly after menopause leading to an increased risk for developing osteoporosis in women. Therefore, by acting similar to estrogen on bones without its associated risks elsewhere in body such as breast cancer and endometrial hyperplasia or cancer (uterus), Evista helps delay onset or progression of postmenopausal osteoporosis.

What is Evista?

Evista is a brand name for raloxifene, which is a selective estrogen receptor modulator (SERM) that acts like estrogen in some parts of the body. Its primary use is to prevent and treat osteoporosis in postmenopausal women. It was first approved by the FDA in 1997. Unlike bisphosphonates such as Fosamax, it does not directly inhibit bone resorption, but it mimics estrogen's beneficial effects on bone density without some of the risks associated with estrogen (like breast cancer and uterine cancer). This makes its side-effect profile different from that of bisphosphonates; while it may cause hot flashes and increase risk of blood clots, unlike Fosamax it doesn't carry risks like jawbone decay or esophageal irritation. The unique mode of action can make Evista an appealing choice for certain patients who cannot tolerate other treatments for osteoporosis, such as those offered by typical bisphosphonate drugs like Fosamax.

What conditions is Evista approved to treat?

Evista, also known by its generic name raloxifene, is an FDA-approved drug predominantly used for the following:

  • Prevention and treatment of osteoporosis in postmenopausal women
  • Reduction in risk of invasive breast cancer in postmenopausal women with osteoporosis or at high risk for breast cancer

How does Evista help with these illnesses?

Evista, also known as Raloxifene, is a selective estrogen receptor modulator (SERM) that plays roles in many processes in the body. It acts like estrogen to protect bone health, which can be beneficial for post-menopausal women who are at an increased risk of osteoporosis due to low levels of natural estrogen. Fosamax works by slowing down the process that makes old bone cells break down, thereby increasing overall bone mass and reducing the likelihood of fractures. However, unlike Evista which has added benefit on breast tissue and potentially reducing breast cancer risk in some women, Fosamax doesn't have this additional advantage. Therefore, when considering both factors -bone health and breast cancer prevention- Evista may be preferred over Fosamax for certain patients as per their individual medical history and needs.

How effective are both Fosamax and Evista?

Both alendronate (Fosamax) and raloxifene (Evista) have established histories of success in preventing and treating osteoporosis, having been approved by the FDA in 1995 and 1997 respectively. Both medications function differently; Fosamax is a bisphosphonate that slows bone loss while Evista mimics estrogen's beneficial effect on bone density without some of the risks associated with estrogen.

The effectiveness of Fosamax and Evista was directly compared in numerous clinical trials. For example, a study published in 2004 found that both drugs were effective at reducing vertebral fracture risk but only Fosamax significantly reduced the risk for non-vertebral fractures.

A review of meta-analysis reports on Fosamax demonstrated its efficacy in increasing bone mineral density from the first year of treatment, exhibiting fewer gastrointestinal side effects compared to other bisphosphonates, and showing good tolerance across different populations including post-menopausal women. The same study highlighted Fosamax as one of the most prescribed osteoporosis drugs globally due to its proven track record in reducing fracture incidence.

On the other hand, a 2016 review indicated that Evista not only helps prevent spinal fractures but also has an added benefit over many osteoporosis treatments - it reduces breast cancer risk among postmenopausal women with osteoporosis or those at high risk for invasive breast cancer. However, like all medications it comes with potential drawbacks such as hot flushes and leg cramps which are reported more frequently than with placebo or bisphosphonates such as fosamax.

While both drugs are recommended as first-line treatment options for prevention and treatment of postmenopause-related osteoporotic changes depending upon individual patient needs preferences & contraindications if any exist.

abstract image of a researcher studying a bottle of drug.

At what dose is Fosamax typically prescribed?

Oral dosages of Fosamax range from 5-70 mg/day, depending on the condition being treated. For osteoporosis prevention in postmenopausal women, a dosage of 5 mg/day or 35 mg/week is recommended. Those who are treating osteoporosis may take either 10mg/day or 70mg/week. On the other hand, Evista is typically prescribed at a consistent daily dose of 60 mg regardless of the condition's severity. Unlike with Fosamax, there isn't an option to vary your Evista intake based on specific treatment goals or responses after several weeks. It should be noted that these medications should only be taken under the supervision and advice of a healthcare provider.

At what dose is Evista typically prescribed?

Evista treatment is generally initiated at a dosage of 60 mg/day, which can be taken at any time during the day. Unlike Fosamax, it doesn't need to be administered on an empty stomach or require the patient to remain standing or sitting upright for a period post-administration. The daily dose remains consistent and does not typically increase over time as with some other treatments. However, Evista should always be used under medical supervision and regular check-ups are recommended to monitor response to treatment and adjust dosages if necessary.

What are the most common side effects for Fosamax?

Common side effects of Fosamax (Alendronate) can include:

  • Abdominal or stomach pain
  • Constipation, diarrhea
  • Difficulty swallowing
  • Dizziness, headache
  • Musculoskeletal (bone, muscle or joint) pain
  • Nausea

In contrast, Evista (Raloxifene) may cause the following common side effects:

  • Hot flashes and sweating
  • Leg cramps
  • Swelling of the feet, hands and legs
  • Flu-like symptoms such as fever and chills.

Always consult your healthcare provider to ensure that any discomfort you experience is not a sign of a more serious condition. It's also important to note that these medications are used for different conditions. Fosamax is primarily prescribed for osteoporosis treatment while Evista is commonly used in treating osteoporosis and reducing risk of invasive breast cancer for postmenopausal women.

abstract image of a patient experiencing side effect

Are there any potential serious side effects for Fosamax?

While taking Fosamax can generally be considered safe, some individuals might experience severe side effects such as:

  • Difficulty or pain when swallowing
  • Chest pain, new or worsening heartburn
  • Severe joint, bone, or muscle pain
  • New or unusual hip/thigh/groin pain
  • Jawbone problems including infection and slow healing after dental work

On the other hand, Evista could also cause serious side effects like:

  • Signs of a blood clot in the lung - chest pain, sudden coughing with bloody mucus, shortness of breath and rapid breathing
  • Signs of a stroke – sudden numbness/weakness especially on one side of the body; sudden confusion/trouble speaking/vision difficulties/balance issues; unexplained headache/dizziness
  • Symptoms indicating high calcium levels in the blood – excessive thirst/urination, constipation/appetite loss/nausea/vomiting/tiredness/muscle weakness/joint ache/confusion/memory issues.

If any of these symptoms occur while using either medication it is advised to seek immediate medical attention.

What are the most common side effects for Evista?

When choosing between Fosamax and Evista for the treatment of osteoporosis, it's important to consider potential side effects. Commonly reported reactions that you might experience with Evista include:

  • Hot flashes
  • Leg cramps
  • Swelling of the legs, ankles or feet
  • Cold-like symptoms such as stuffy nose, sneezing and sore throat
  • Increased sweating
  • Mild nausea or stomach pain
  • Difficulty sleeping or insomnia
  • Mild skin rash
  • Headache, dizziness or spinning sensation While these are most common, other less frequently experienced but more severe side effects can occur. Always consult your health care provider about any unusual reaction while on medication.

Are there any potential serious side effects for Evista?

While Evista is generally well-tolerated, it can potentially cause serious side effects in rare cases. These might include:

  • Symptoms of a severe allergic reaction such as skin rash, hives or itching; fever or swollen glands; difficulty breathing; swelling in your face, lips, tongue or throat.
  • Chest pain or pressure that may spread to the jaw or shoulder accompanied by nausea and sweating - these could be signs of a heart attack.
  • Sudden vision problems like blurred vision which could indicate a blood clot in the eye.
  • Stroke symptoms including sudden numbness (especially on one side of the body), trouble speaking, severe headache and loss of balance.
  • Blood clots manifesting as warmth, redness and pain in an arm or leg.

If you experience any of these symptoms while taking Evista, seek immediate medical attention.

Contraindications for Fosamax and Evista?

Both Fosamax and Evista, along with most other osteoporosis medications, may lead to certain side effects. If you notice severe joint or muscle pain, unusual thigh bone fractures, or changes in your vision, immediately contact your healthcare professional.

Neither Fosamax nor Evista should be taken if you have low levels of calcium in your blood (hypocalcemia) or problems with the part of your esophagus that allows you to swallow. Always inform your physician about any medical conditions you have; issues such as these need to be corrected before starting therapy with either medication.

Moreover, both drugs can interact negatively with other medications including antacids and supplements containing calcium or iron for Fosamax, while estrogen hormones could potentially interfere with the efficacy of Evista. Therefore it's crucial to disclose all over-the-counter products and prescribed medicines you are currently taking.

How much do Fosamax and Evista cost?

For the brand name versions of these drugs:

  • The cost for a one month supply (4 tablets) of Fosamax (70 mg) averages around $145, which works out to approximately $36.25 per week or about $5.18/day.
  • The price for 30 tablets of Evista (60 mg) is approximately $220, working out to roughly $7.33/day.

Thus, if you are prescribed a weekly dosage regimen, as is common with Fosamax (i.e., 70 mg/week), then it may be less expensive on a per-day treatment basis compared to daily use of Evista.

Please note that cost should not be your primary consideration in determining which drug is right for you; effectiveness and side effects are also crucial factors.

In terms of generic versions:

  • Alendronate sodium, the generic version of Fosamax, costs between $8 and $15 for four 70mg tablets depending upon where you purchase them from - this equates to about $.57-$1.07/day.
  • Raloxifene hydrochloride, the generic form of Evista can range from around $20 to$50+ for thirty 60mg tablets - this puts its daily pricing at approximately $.67-$1.67+.

Popularity of Fosamax and Evista

Alendronate, available in generic form and under the brand name Fosamax, was prescribed to about 2 million people in the US in 2020. The drug belongs to a class called bisphosphonates which is used primarily to treat osteoporosis and similar bone diseases. It accounted for nearly 30% of all prescriptions for this class of medications. Alendronate’s use has been generally steady over the past decade.

Raloxifene, also known as Evista, is another medication used primarily to prevent and treat osteoporosis in postmenopausal women. In 2020, it was prescribed to roughly half a million people in the USA. Raloxifene accounts for close to 10% of prescriptions within its own classification (Selective Estrogen Receptor Modulators or SERMs), making it less prevalent than alendronate but still a significant player among treatments for osteoporosis. Its usage trend has remained relatively constant over recent years.


Both Fosamax (alendronate) and Evista (raloxifene) have well-documented records of usage in patients with osteoporosis, supported by numerous clinical studies indicating that they are more effective than placebo treatments. On occasion, the drugs may be used together, but this would require careful consideration from a physician due to potential contraindications. Their different mechanisms of action contribute to their distinct prescribing situations: Fosamax works by slowing bone loss while increasing bone mass, which can prevent fractures; whereas Evista mimics estrogen's beneficial effects on bone density in postmenopausal women without some of the risks associated with the hormone.

Both medications are available as generics, representing significant cost savings for patients who must pay out-of-pocket. The desired effects of both Fosamax and Evista might not be immediately noticeable because these drugs work over time to improve bone health.

The side effect profile is somewhat similar between the two drugs - both generally being well-tolerated - with Fosamax less likely to cause hot flashes compared to Evista. However, both medications carry a small risk of serious side effects such as blood clots or esophageal problems that should prompt immediate medical attention.